Anticoagulation Certificate

   
The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.

This activity is intended for pharmacists seeking to expand their knowledge and skills in anticoagulation therapy management.

Introduction to Anticoagulation
ACPE #: 0204-0000-23-700-H01-P

• Identify the components of the intrinsic and extrinsic clotting cascade.
• Describe how fibrinolysis occurs in the human body.
• Explain anticoagulant mechanisms of action in relationship to the clotting cascade.
• Describe milestones in the evolving use and management of anticoagulation therapy.
• Identify regulatory and accreditation influences on anticoagulation management.
• Explain the importance of pharmacists in optimizing the overall anticoagulation management plan. 

Heparin, Low Molecular Weight Heparin, and Venous Thromboembolism Prophylaxis
ACPE #: 0204-0000-23-701-H01-P

• Identify the differences among unfractionated heparin, low molecular weight heparin (LMWH), and fondaparinux.
• Explain how to initiate and monitor heparin, low molecular weight heparin, and fondaparinux for various indications.
• Recommend dose adjustments of heparin, low molecular weight heparin, and fondaparinux based on patient specific considerations.
• Apply a venous thromboembolism risk assessment model to determine risk for venous thrombosis in medical or surgical patients.
• Compare the difference in safety and efficacy of venous thromboembolism prophylaxis regimens in medical or surgical patients.
• Design an optimal VTE prophylaxis regimen in medical or surgical patients. 

Arterial Disease and Venous Thromboembolism Treatment
ACPE #: 0204-0000-23-702-H01-P

• Describe how acute venous thromboembolism (VTE) is diagnosed.
• Identify evidence-based anticoagulant options with recommended dosing for initial VTE treatment.
• Design an individualized anticoagulant plan for a patient with an acute VTE case including risk-benefit assessment and determination of duration of anticoagulant therapy.
• Compare and contrast the key characteristics and treatment considerations for arterial versus venous thromboembolism.
• Design an appropriate antithrombotic treatment regimen for coronary artery disease patients who also have either atrial fibrillation or venous thromboembolism.
• Compare and contrast the key characteristics and treatment considerations for arterial versus venous thromboembolism.
• Design an appropriate antithrombotic treatment regimen for peripheral artery disease and cardiovascular disease patients. 

Thrombolytic Therapy
ACPE #: 0204-0000-23-703-H01-P

• Given a patient case, assess a patient’s potential benefits and risks, including contraindications, associated with thrombolytic therapy.
• Design an appropriate thrombolytic treatment plan for a patient with a life- or limb threatening thrombosis.
• Design a subsequent antithrombotic treatment plan for a patient with a life- or limb threatening thrombosis. 

Warfarin and Focus on the Ambulatory Setting
ACPE #: 0204-0000-23-704-H01-P

• Select an appropriate starting dose, INR follow-up plan, and key patient education points for a patient starting warfarin therapy.
• Determine an appropriate dosing/management strategy based on the clinical situation when a patient on warfarin presents to the hospital.
• Determine an appropriate dosing/management strategy based on the clinical situation when a hospitalized patient on warfarin transitions to a different level of care (critical care, sub-acute, home).
• Develop an effective management strategy when a patient experiences a clinically significant drug-drug or dietary interaction.
• Formulate an effective management strategy when presented with an ambulatory patient struggling with warfarin therapy.
• Identify the key components, characteristics, and activities for management of patients in a high-performing outpatient anticoagulation service.
• Modify a patient’s anticoagulation therapy in the management of warfarin, low molecular weight heparin (LMWH) and direct oral anticoagulant (DOAC) medications in an outpatient anticoagulation service.
• Summarize how to document care in the management of medications in an outpatient anticoagulation service.

 Oral Direct Thrombin Inhibitors (DTI), Anti-Xa Agents, and Atrial Fibrillation
ACPE #: 0204-0000-23-705-H01-P

• Compare appropriate clinical and patient specific characteristics for DOAC and warfarin therapy.
• Identify potential organ system and drug interactions with DOACs.
• Design appropriate management strategies for a patient with organ system and drug interaction with DOACs.
• Develop a plan to successfully convert a patient from warfarin to a DOAC.
• Categorize an atrial fibrillation patient’s risk of stroke and bleeding in order to make treatment decisions.
• Develop an individualized anticoagulation plan for a patient with atrial fibrillation.
• Describe anticoagulation considerations related to ablations and anticoagulation alternatives in atrial fibrillation. 

Anticoagulation in Special Populations
ACPE #: 0204-0000-23-706-H01-P

• Describe skills required by a pharmacist to assess if a patient requires special management considerations.
• Design monitoring parameters for a patient within a special population receiving an anticoagulant.
• Describe how factors for patients within special populations can alter risk for bleeding or thrombosis independent of direct effects on the anticoagulation regimen.
• Analyze anticoagulation-related outcomes in the obese patient population.
• Select appropriate anticoagulant therapy for patients with obesity.
• Select appropriate anticoagulant therapy in a patient within a special population (renal failure).
• Analyze anticoagulation-related outcomes in patients with renal insufficiency.
• Select appropriate anticoagulant therapy in patients with renal insufficiency.
• Describe how factors associated with the geriatric patient population can alter risks of bleeding and thrombosis independent of direct effects on the anticoagulation regimen.
• Analyze anticoagulation-related outcomes in the geriatric patient population.
• Select appropriate anticoagulant therapy for patients in the geriatric patient population.
• Discuss characteristics in pregnant women that put them at higher risk for VTE.
• Apply key components for managing a pregnant patient with a VTE before, during, and after delivery.
• Apply components and activities for managing a pediatric patient requiring anticoagulation therapy for a VTE. 

Mechanical Devices and Focus on the Acute Care Setting
ACPE #: 0204-0000-23-707-H01-P

• Discuss common, current medical devices that require anticoagulation.
• Analyze a patient’s device-specific anticoagulation regimen.
• Design a patient- and device-specific anticoagulation regimen.
• Review common, current medical devices that require anticoagulation.
• Explain challenges that can occur with anticoagulants in the acutely and critically ill patient.
• Describe characteristics of effective anticoagulation management specific to acutely ill patient.
• Summarize what a pharmacist needs to consider in adapting anticoagulant therapy to the acutely ill patient. 

Heparin Induced Thrombocytopenia (HIT) Treatment and Hypercoagulable Conditions
ACPE #: 0204-0000-23-708-H01-P

• Describe the pathophysiology and approaches to recognize heparin-induced thrombocytopenia (HIT).
• Discuss approaches to managing HIT.
• Discuss how to initiate and manage anticoagulation therapy in HIT.
• Discuss how to initiate and manage parenteral direct thrombin inhibitors.
• Describe the clinical presentations and testing considerations for hypercoagulable conditions.
• Develop a management plan to mitigate the risk of thrombosis in patients.
• Assess the role of cancer as a hypercoagulable state and the use of risk assessment scores to determine management strategies.
• Assess the role of cancer as a hypercoagulable state.
• Apply risk assessment scores to determine anticoagulation management strategies in patients with cancer. 

Laboratory Assessments
ACPE #: 0204-0000-23-709-H01-P

• Explain analytical tests utilized in the assessment and management of anticoagulant agents.
• Summarize the limitations of anticoagulant assays.
• Design an anticoagulation management plan that incorporates assays for decision support. 

Reversing Anticoagulation and Peri-Operative Management
ACPE #: 0204-0000-23-710-H01-P

• Describe potential bleeding challenges during anticoagulation therapy.
• Design an anticoagulation agent-specific reversal plan.
• Summarize available anticoagulant medications and ways to reverse their effects.
• Describe the various agents used to reverse anticoagulant effects.
• Summarize invasive procedures and related risks for bleeding and thrombotic complications.
• Design an anticoagulation management approach when an invasive procedure is planned.
• Analyze a patient’s specific anticoagulation regimen and estimate when effects may be absent. 

Skills for Managing Anticoagulation Therapy
ACPE #: 0204-0000-23-711-H01-P

• Discuss the skill set needed for initiating and developing anticoagulation therapy management plans.
• Describe skills for assessing and adjusting anticoagulation management plans.
• Re-define a pharmacist’s role in managing anticoagulation therapy.
• Name key concepts learned in managing anticoagulation therapy.
• Prepare a plan for continued self-development to evolve as an anticoagulation therapy provider.
• Summarize a pharmacist’s role in managing anticoagulation therapy.
• Apply concepts learned in managing anticoagulation therapy.
• Prepare a plan for continued self-development to evolve as an anticoagulation therapy provider. 

Antithrombotic Stewardship
ACPE #: 0204-0000-23-712-H01-P

• Describe the core elements of an antithrombotic stewardship program.
• Apply principles of antithrombotic stewardship within your current practice site.

In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company.

An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience. 

Michael P. Gulseth, PharmD, BCPS, FASHP, FMSHP

• Janssen Pharmaceuticals: Speaker
• CSL Behring: Speakers bureau
• Diagnostica Stago, Inc. (“Stago U.S.”): Speakers bureau

All other persons in control of content do not have any relevant financial relationships with an ineligible company. 

As defined by the Standards of Integrity and Independence definition of ineligible company. All relevant financial relationships have been mitigated prior to the CE activity.

This online activity consists of a combined total of 13 learning modules. Pharmacists are eligible to receive a total of 38 hours of continuing education credit by completing all 13 modules within this professional certificate. 

Participants must participate in the entire activity and complete the evaluation and all required components to claim continuing pharmacy education credit online at https://elearning.ashp.org. Follow the prompts to claim credit and view your statement of credit within 60 days of completing the activity. 

Important Note – ACPE 60 Day Deadline:

Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP eProfile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity.